McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 53 National Cancer Institute-designated comprehensive cancer centers in the U.S.
Case Manager Registered Nurse, IN - Remote
We are looking for a Case Manager RN to join us in leading our organization forward.
McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
Position Summary:
This position is responsible for care management functions. This includes but is not limited to the following: participates in the medical management of members in assigned product lines, including case specific and disease management programs, including catastrophic cases. Works with the PCP, the member and management to promote the delivery of quality services at the most appropriate and cost-effective setting.
Performs as the member advocate with emphasis on education regarding managed care, disease management and PCP treatment plans. Monitors member’s utilization patterns for identification of high risk, and under and overuse of services. Collaborates with Medical Director and senior management on complex cases and special projects.
This position is fully remote.
Qualifications:
Required:
- RN with a valid unrestricted license from the state employed in providing services.
- One (1) year previous case management or utilization review experience.
Preferred:
- BSN
- Certified Case Manager (CCM) Certification.
- Two (2) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions including understanding of claims administration, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.
- Obstetrics or OB/GYN RN experience.
Additional Information
- Schedule: Full-time
- Requisition ID: 24007034
- Daily Work Times: 8:00 am - 5:00 pm
- On Call: No
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
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